Project Summary/Abstract Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death and fourth leading cause of disability in the United States (US). Nearly 12 million adults live with its progressively worsening symptoms but have yet to be diagnosed. Significant disparities in late stage diagnosis exist in rural patient populations, specifically those in the southeastern region of the US where tobacco use is highest. Alleviating the burden of late stage COPD diagnosis through smoking cessation and screening is a national priority, as outlined in the 2017 National COPD Action Plan. Health communication campaigns have been effective in promoting both smoking cessation and health screening behaviors in the general US population, but their efficacy in rural regions of the nation is unknown. Moreover, these campaigns rarely bring attention to the mild symptoms of tobacco-associated diseases and the benefits of early detection. Culturally adapting messages to the unique needs and preferences of rural adults at-risk for COPD and experiencing its mild symptoms has important implications for enhancing proactive health behaviors against poor outcomes associated with its late stage diagnosis. The purpose of this NRSA F32 Fellowship proposal is to receive mentored training that will allow me to identify and test the combination of message attributes that are most likely to promote smoking cessation and screening behaviors among subgroups of rural adults at-risk for COPD in a southeastern region of the US. In Specific Aim 1, I will conduct a sequential exploratory mixed-method (qual-quant) to explore the psychosocial attributes of smoking cessation and COPD screenings. In Specific Aim 2, I will design and conduct an intervention to test how preferences for message attributes related to smoking cessation and screening behaviors vary among rural adults at-risk for COPD, by gender and race. Throughout this NRSA F32 Fellowship, I will receive structured and intensive didactic, experiential, and professional development training from a transdisciplinary panel of experts in targeted health message design interventions, tobacco control research, experimental design methodology, and rural health disparities in smoking cessation and health screening behaviors. My long-term career goal is to become a leading mixed-methods transdisciplinary researcher with expertise in developing, implementing, and evaluating strategic health messages to support proactive tobacco-associated lung disease behaviors among medically underserved populations. This NRSA F32 Fellowship training experience will allow me to conduct a mentored and applied transdisciplinary research study that advances my potential as an independent researcher. The mentored research study will also address a national priority to improve the lives of all those affected by COPD, specifically by examining factors that contribute to late stage COPD diagnosis in vulnerable populations.